It started on a hot summer day—or at least that’s when I first noticed. Tired from a morning of playing outside in the sun, my 6-year-old son sunk into the couch, freeze pop in hand, mindlessly watching cartoons. As his eyes followed the show on the screen, they suddenly opened wide, darted to the right then rolled down. He blinked, still watching the TV, totally unphased.
At first I didn’t think much of it. A simple twitch or maybe allergies, I thought. But then he did it again. And again.
Throughout the evening—and into the following weeks—it repeated. Eyes wide, side, roll—over and over. I was puzzled and becoming worried. What was going on?
Did his eyes hurt? Was he tired? To all my questions he answered no. And the more I prodded at the issue, the more the eye rolling happened.
“It’s a developmental tic,” his pediatrician told me when I pulled her aside at his annual checkup. “It’s much more common than you might think.”
Tics in Kids
Tics are repetitive, involuntary movements or sounds, and indeed, they’re common in childhood. Whether motor or vocal, about 10% of kids will experience tics at some point, says Dr. Jeffrey Waugh, a Pediatric Neurologist at Children’s Health in Dallas where he’s part of the Movement Disorders Program. But that 10% is just the children who get a diagnosis.
“That’s the starting point of the kids who actually make it to see a researcher or a specialist,” Waugh says. “There are a lot of tics that go away quickly enough that you never make it to a specialist. So there’s probably an even larger number of kids.” The National Institutes of Health estimates that transient tics affect at least 20% of school-age children, or 1 in 5 kids.
You’ve likely seen a tic and not even realized it: A repeated blink, a frequent shoulder shrug, or a constant clearing of the throat. People who have tics cannot stop their body from doing these things.
The normal history for tics is that they wax and wane, and for many people they can go away entirely during the dip.
Tics typically onset between the ages of 7 to 9, but there can be spill over on either side, says Waugh. It’s uncommon for tics to begin after the tween years. They’re more in common in boys.
Though they can be scary for parents who might wonder if they’re a sign of something more serious, childhood tics are usually temporary and nothing to worry about.
“By the time a kid reaches their mid-20s, one-third of the tics will entirely go away, one-third will get a lot better, and one-third will continue at about the same intensity they were when they were young,” says Waugh. “The normal history for tics is that they wax and wane, and for many people they can go away entirely during the dip. I’ve had more patients than I can count where I see them for an initial evaluation and then [the tics] go away, and I see them back a year later and they’ve still gone away, and I never hear from them again.”
What makes a kid tic?
A kid will tic because they have an urge to do a movement or make a sound that creates a feeling of relief. But what’s behind that urge? No one knows for sure. And while some studies suggest that tic disorders could run in families, the link is not always direct.
“There’s a group of medical conditions that kind of all travels together. And sometimes that shows up as tics but sometimes it shows up as other disorders,” Waugh explains. “So people who have tics also have an increased risk of ADHD, obsessive compulsive disorder, anxiety disorder and autism. And in one family member it may come out as tics and in another family member it may come out as one of these other issues.”
While experts don’t know exactly why tics happen, they do know what makes them worse.
“Anything that is serving as a stress on the system will make tics more likely to come out,” Waugh explains. “That can be things like having and illness, fatigue, getting a bad night’s sleep the night before.” Certain medications can also make tics worse, as well as drawing attention to them.
For Sophie Mattix, a twice exceptional 6-year-old from Fort Worth, anxiety is the main driver of her tics. They started around age 5 with hard blinking when talking to new people. “From there we have had marching in place, clicking, and sniffing,” says her mom, Rebecca Mattix. Sophie’s tics come and go, lasting for about nine months at a time. “Maybe we’ll have a couple of months without them, but then they start up again,” Mattix says. “For Sophie, triggers are talking to new people, trying to get out big thoughts, or feeling that something is ‘dirty.’”
Treating childhood tics
Identifying and managing those triggers is often the best way to help children with tics. This could mean treating anxiety with medication or therapy, for example.
But tics are not harmful and for most kids, no treatment is needed. They can come and go and change over time, so if you notice a tic, you might take a wait and see approach. It’s OK to ask your child about it but try not to mention it too much—drawing attention to them can make tics worse.
So when does a child need treatment? Or to see a doctor? “There’s not a hard and fast answer and every family is different in how much worry there is about this,” says Waugh. “If a parent is concerned, they should always feel free to seek out an opinion.” Start by talking to your pediatrician.
The decision to treat, experts say, is based on the impact to their quality of life—if tics are interfering with daily life, social interactions, or school performance. The best way to tell if your child needs intervention is to gauge how it’s affecting them.
“Talk to their teacher and find out whether this is something that’s giving them a hard time. If it is impairing them in the classroom, if they are having to spend 50 percent of their attention on controlling it and thus not learning, that’s a problem too,” says Waugh. “If a parent is seeing that their kid is distressed about it, or hearing about problems at school related to it, those are instances in which I’d seek the advice of a physician.”
The Rise in Functional Tic-Like Behaviors
In the past few years, experts have seen a surge in functional tic-like behaviors; a movement disorder that involves a sudden onset of tic-like symptoms. The patients are often teenagers—predominantly female—who have no history of tics.
“This is different than a tic disorder that onsets earlier in childhood,” says Dr. Waugh. In these cases, the symptoms are distinctly different from those in tic disorders, yet they are similar to one another. “People who have functional tic-like movements tend to look like others—the presentation of that problem has a look to it.”
Many experts believe that increased social media use combined with other stressors could be behind the uptick. “The reasons for [the increase] are almost certainly related to isolation, anxiety, depression, which all worsened among not just teens, but many of us, during the pandemic,” says Waugh.
This article was originally published in October 2023.
Top image: iStock
